Managing Maximus

Last week's state supreme court decision barring the Giuliani administration from awarding more than $100 million in welfare-to-work contracts to the Virginia-based Maximus cast that companynot to mention the mayorin an unflattering light. It turns out city officials had met with Maximus executives even before they let other contenders know the huge contract was up for grabs. The city also failed to consider that the company landed in a criminal investigation in West Virginia over its tactics for seeking a contract in that state, according to the ruling. Meanwhile, a former Giuliani administration staffer, Richard Schwartz, was due 30 percent of the whopping total through a subcontract with Maximus.

While a city appeal of the ruling puts Maximus's job-finding project on hold (leaving thousands of welfare recipientsand, presumably, Schwartzto find other paths to meaningful employment), the uncomfortable spotlight is now widening to include another Maximus contractfor $24 millionto enroll those on medicaid in managed care.

The 1998 agreement enlisted Maximus to educate city residents on medicaid about managed care and help them enroll in plans. But, according to its critics, the company has done a poor job of explaining the complicated process, making it difficult for recipients who have been inappropriately swept into HMOs to get out.

Dissatisfaction with the company has been mounting for months. Since December, when the transition to managed care became mandatory, advocates for the poor have complained that Maximus hasn't provided adequate educational materials in languages other than English, leaving many who rely on the program confused about how to get health care.

Maximus spokesperson Rachael Rowland says the company "takes pains" to work with people in their own languages and notes that, despite such complaints, 81 percent of the people they serve have picked their own HMOs, rather than being assigned to them, which is considered a sign of success within the industry.

But the company's eagerness to have medicaid recipients enroll in HMOsone of the criteria on which the company's success is measuredmay make it difficult for some to get out of HMOs.

"They can sign someone up in about 30 seconds, and it takes about six or eight weeks to get them out," says Julia Stewart, a social worker at the Bridge, which provides services to the homeless mentally ill. According to Stewart, her clients don't have the wherewithal to navigate the bureaucratic process of getting exemptions from managed care.

Indeed, though technically allowed them, people with HIV or other chronic illnesses say such exemptions are hard to come by. And Maximus has not granted any exemption requests based on language barriers, despite the fact that 214 people have applied for them so far.

Medicaid recipients are allowed to opt out of the HMO system if they can't find a plan that has at least three physicians within 30 minutes of their home who speak their language. But according to a pending civil rights complaint, many non-English-speakers seeking exemptions face a frustrating runaround. In one case, Maximus gave a list of 42 physicians who were supposed to speak Russian to an immigrant from Belorussia who had requested an exemption from managed care. According to the complaint, which alleges that such problems are widespread, only one of those doctors actually spoke Russian and worked within the immediate area.

In February, Public Advocate Mark Green detailed other failings in Maximus's managed care effort. Green noted that only two of 27 providers were accurately represented by the company's telephone help line. Maximus counselors also gave callers inadequate or incorrect information two-thirds of the time, according to the report.

Maximus spokesperson Rowland notes that other reviews of the help line did not find the same level of problems and says the company is taking Green's criticism to heart.

Apparently, H. Carl McCall is too. The comptroller wrote a letter to state health commissioner Antonia Novello expressing concern about the criticisms raised in Green's report. Novello's office says she is drafting a response that will recommend renewing and extending the Maximus contract. In the meantime, Maximus's other problems seem likely to affect its future in the medicaid managed care business.

According to McCall staffer Dennis Thomson, "When a government entity has serious concerns about a contractor and the state is entering a contract with the same entity, it'd be irresponsible not to take that into consideration."